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Hip fractures are as common as 100 to 500/100,000 individuals in the elderly population, resulting in increased mortality and morbidity following the fractures and their treatments. [1][2][3] For the patients over the age of 65 years, intracapsular fractures like femoral head and neck fractures are commonly treated with hemiarthroplasty (HA), and extracapsular fractures such as trochanteric fractures with proximal femoral nailing (PFN). [4,5] Open reduction and internal fixation for femoral head and neck fractures are preferred for non-displaced stable fractures in younger population. For trochanteric fractures, with the development of new generation PFNs, and studies showing more favorable results in terms of functional results, Objectives: This study aims to compare the effects of hemiarthroplasty (HA) and proximal femoral nailing (PFN) on postoperative cognitive function in elderly adults with hip fractures.Patients and methods: Between August 2021 and January 2022, a total of 49 patients (28 males, 21 females; mean age: 78.1±9.4 years; range, 65 to 96 years) presented with a proximal femoral fracture were included. The patients were divided into two groups based on the type of surgical technique used. Group 1 consisted of 23 patients who underwent cemented HA, while Group 2 consisted of 26 patients who underwent osteosynthesis with a PFN. Preoperatively (24 h before surgery), within the first week (Days 4 to 7), and at one month following surgery, the Mini-Mental State Examination (MMSE) was applied. Results:The surgery side and duration of surgery were not significantly different between the two groups (p>0.05); however, the length of hospital stay and estimated blood loss were significantly different (p<0.001) in favor of Group 2. When the decline in MMSE scores from preoperative to postoperative was assessed, it was shown that Group 2 had a lesser decrease. Conclusion:Patients with hip fractures who underwent PFN surgery experienced less postoperative cognitive impairment than those who underwent HA surgery.